Hannah Barker

Background: The nursing workforce globally faces significant challenges, including burnout, stress, and absenteeism, exacerbated by unsafe staffing levels and suboptimal working conditions. In England, many nursing staff express intentions to leave their roles, driven by work-life imbalance. This study explores how the preferences and constraints of nursing staff, nurse managers, and hospital directors interact to influence shift scheduling decisions within the NHS, aiming to identify strategies that reconcile individual wellbeing with organisational imperatives. Methods: This qualitative study employed framework analysis, guided by the Thomas-Kilmann Conflict Mode Instrument (TKI) to understand conflict management approaches in shift scheduling. Data were collected through semi-structured interviews with 17 nursing staff, five nurse managers, and six hospital directors across five diverse NHS Trusts in England. Interviews were conducted remotely, transcribed verbatim, and analysed to identify key themes and patterns. Results: Three primary themes were identified: Balancing Choice with Consistency, Predictability, and Flexibility; Adequate Rest and Recovery Between Shifts; and Enjoyment and Engagement at Work. The study found that collaborative and compromising conflict management approaches were most effective in preventing potential conflicts from escalating into actual conflicts. Flexible and predictable scheduling was crucial for enhancing nurse wellbeing and retention, while rigid policies often led to increased turnover and reduced morale. The study also highlighted the importance of considering external constraints, such as caring responsibilities, which can limit the effectiveness of workplace solutions. Conclusions: Effective nurse shift scheduling requires a blend of conflict management strategies, with an emphasis on collaborative and compromising approaches. By prioritising flexible scheduling and proactive communication, healthcare organisations can better support their nursing workforce, enhancing both individual wellbeing and organisational efficiency. These findings have significant implications for improving the sustainability and quality of healthcare service provision.

Aim: To understand how preferences and constraints of nursing staff, nurse managers and hospital directors interact and influence decisions around nurse shift patterns Background: Globally, many nursing staff have expressed intention to leave the profession and high levels of stress and burnout. Shift patterns are often cited as a key driver of negative nurse outcomes. How preferences and constraints of staff groups involved in nurse shift scheduling interact to shape decisions remains unexplored. Design: Qualitative study. We interviewed 17 nursing staff, 5 nurse managers and 6 hospital directors. Methods: Staff were recruited through 5 NHS Trusts based in the North, Midlands, East and South of England. The results were analysed using inductive and deductive framework analysis. Results: Three themes were identified that influenced nurses’ decisions for shift scheduling: 1/ Balancing Choice with Consistency, Predictability and Flexibility; 2/Adequate Rest and Recovery Between Shifts; and 3/Enjoyment and Engagement at Work. There was a meta-theme of conflicting priorities for shift scheduling between nursing staff, nurse managers and hospital directors across these three themes. Conclusions: Different priorities for shift scheduling of nursing staff, nurse managers and hospital directors created potential or actual conflict. Solutions appeared to consist of compromises where priorities of different staff groups were simultaneously upheld to an acceptable level. This occurred through collaborative interactions across staff groups. Implications for Practice: Nursing staff, nurse managers and hospital directors can facilitate choice and flexibility and navigate conflicts in nurse shift scheduling through collaborative approaches that enhance awareness and effective communication. Reporting Method: Qualitative data was reported using the EQUATOR checklist COREQ. No Patient or Public Contribution What does this paper contribute to the wider global clinical community? Collaborative approaches can influence conflicting priorities of staff groups in relation to nurse shift scheduling. Staff understanding other staff priorities for nurse shift scheduling enhances awareness.

Global society is wasting food at unsustainable levels, and unconsumed food is contributing markedly to carbon emissions. Simultaneously, food insecurity and obesity are increasingly prevalent concerns in high-income countries. This study aimed to evaluate food waste at the household level to understand relationships between discarded food, food processing and household characteristics. A sociodemographic and food security survey of householders in Hampshire (UK) was conducted alongside a seven-day photographic food waste diary. Of the total food waste from 94 participants, 87% was unprocessed, 51% was avoidable or potentially avoidable and 36% was unavoidable. Of the total food waste, 61% occurred during food preparation. Greater amounts of avoidable food waste occurred in one, three and four+ person households than in two-person households. Potentially avoidable food waste was greater in households educated to postgraduate and university degree level than others. The outcomes of this study indicate that the focus on interventions should vary demographically. Interventions that support food security, improving diet quality and saving money, while reducing avoidable and unprocessed food waste, in one, three and four+ person households during food preparation are one option. Reducing potentially avoidable unprocessed food waste is a priority in households educated to university degree level and above.

In European countries over 40% of food loss and waste occurs at the retail and consumer stages; this situation cannot be sustained and remediation is urgently needed; opportunities for change must be created. “Nudge” techniques have been shown to be effective in changing behaviour in areas related to food consumption (e.g., healthy diet), but the effectiveness of interventions using nudge techniques to change food waste behaviours remains unclear, despite a growing body of research. The aim of this review is to elucidate means to change household food waste behaviour using nudge approaches and identify priority needs for further research. Four databases, grey literature and reference lists were searched systematically to identify relevant research on nudges to change food waste behaviours. This search identified sixteen peer-reviewed research articles and two grey literature reports that were critically appraised using a critical appraisal checklist framework for descriptive/case series. Four studies deemed reliable show interventions using nudges of social norms, reminders or social norms with disclosure were effective in changing food waste behaviours at the household level, while disclosure alone, i.e., revealing environmental costs of food waste, was not. This review, unique in the application of a critical appraisal, suggests there is reliable information on the effectiveness of nudge for food waste recycling interventions when incorporating nudges of social norms, reminders or disclosure alongside use of social norms. If food waste recycling behaviour is considered an upstream measure to raise consumers’ consciousness on the amount of food waste they produce, this may have a positive impact on food waste reduction and therefore has important policy implications for food waste behaviour change at the household level.

Aims and objectives: To synthesise evidence regarding the time nurses take to monitor and record vital signs observations and to calculate early warning scores.Background: While the importance of vital signs’ monitoring is increasingly highlighted as a fundamental means of maintaining patient safety and avoiding patient deterioration, the time and associated workload involved in vital signs activities for nurses are currently unknown.Design: Systematic review.Methods: A literature search was performed up to 17 December 2019 in CINAHL, Medline, EMBASE and the Cochrane Library using the following terms: vital signs; monitoring; surveillance; observation; recording; early warning scores; workload; time; and nursing. We included studies performed in secondary or tertiary ward settings, where vital signs activities were performed by nurses, and we excluded qualitative studies and any research conducted exclusively in paediatric or maternity settings. The study methods were compliant with the PRISMA checklist.Results: Of 1,277 articles, we included 16 papers. Studies described taking vital signs observations as the time to measure/collect vital signs and time to record/document vital signs. As well as mean times being variable between studies, there was considerable variation in the time taken within some studies as standard deviations were high. Documenting vital signs observations electronically at the bedside was faster than documenting vital signs away from the bed.Conclusions: Variation in the method(s) of vital signs measurement, the timing of entry into the patient record, the method of recording and the calculation of early warning scores values across the literature make direct comparisons of their influence on total time taken difficult or impossible.Relevance to clinical practice: There is a very limited body of research that might inform workload planning around vital signs observations. This uncertainty means the resource implications of any recommendation to change the frequency of observations associated with early warning scores are unknown.

Background: Concerns about the degree of compassion in health care have become a focus for national and international attention. However, existing research on compassionate care interventions provides scant evidence of effectiveness or the contexts in which effectiveness is achievable.Objectives: To assess the feasibility of implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings and to evaluate its impact on patient care.Design: Pilot cluster randomised trial (CRT) and associated process and economic evaluations.Setting: Six inpatient ward nursing teams (clusters) in two English NHS hospitals randomised to intervention (n = 4) or control (n = 2).Participants: Patients (n = 639), staff (n = 211) and visitors (n = 188).Intervention: CLECC is a workplace educational intervention focused on developing sustainable leadership and work team practices (dialogue, reflective learning, mutual support) theorised to support the delivery of compassionate care. The control setting involved no planned staff team-based educational activity.Main outcome measures: Quality of Interaction Schedule (QuIS) for staff–patient interactions, patient-reported evaluations of emotional care in hospital (PEECH) and nurse-reported empathy (as assessed via the Jefferson Scale of Empathy).Data sources: Structured observations of staff–patient interactions; patient, visitor and staff questionnaires and qualitative interviews; and qualitative observations of CLECC activities.Results: The pilot CRT proceeded as planned and randomisation was acceptable to teams. There was evidence of potential contamination between wards in the same hospital. QuIS performed well, achieving a 93% recruitment rate, with 25% of the patient sample cognitively impaired. At follow-up there were more positive (78% vs. 74%) and fewer negative (8% vs. 11%) QuIS ratings for intervention wards than for control wards. In total, 63% of intervention ward patients achieved the lowest possible (i.e. more negative) scores on the PEECH connection subscale, compared with 79% of control group patients. These differences, although supported by the qualitative findings, are not statistically significant. No statistically significant differences in nursing empathy were observed, although response rates to staff questionnaire were low (36%). Process evaluation: the CLECC intervention is feasible to implement in practice with medical and surgical nursing teams in acute care hospitals. Strong evidence of good staff participation was found in some CLECC activities and staff reported benefits throughout its introductory period and beyond. Further impact and sustainability were limited by the focus on changing ward team behaviours rather than wider system restructuring. Economic evaluation: the costs associated with using CLECC were identified and it is recommend that an impact inventory be used in any future study.Limitations: Findings are not generalisable outside hospital nursing teams, and this feasibility work is not powered to detect differences attributable to the CLECC intervention.Conclusions: Use of the experimental methods is feasible. The use of structured observation of staff–patient interaction quality is a promising primary outcome that is inclusive of patient groups often excluded from research, but further validation is required. Further development of the CLECC intervention should focus on ensuring that it is adequately supported by resources, norms and relationships in the wider system by, for instance, improving the cognitive participation of senior nurse managers. Funding is being sought for a more definitive evaluation.Trial registration: Current Controlled Trials ISRCTN16789770.Funding: This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 33. See the NIHR Journals Library website for further project information. The systematic review reported inChapter 2was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, the University of Örebro and the Karolinska Institutet.

Objective Compassionate care continues to be a focus for national and international attention, but the existing evidence base lacks the experimental methodology necessary to guide the selection of effective interventions for practice. This study aimed to evaluate the Creating Learning Environments for Compassionate Care (CLECC) intervention in improving compassionate care. Setting Ward nursing teams (clusters) in two English National Health Service hospitals randomised to intervention (n=4) or control (n=2). Intervention wards comprised two medicines for older people (MOPs) wards and two medical/surgical wards. Control wards were both MOPs. Participants Data collected from 627 patients and 178 staff. Exclusion criteria: reverse barrier nursed, critically ill, palliative or non-English speaking. All other patients and all nursing staff and Health Care Assistant HCAs were invited to participant, agency and bank staff were excluded. Intervention CLECC, a workplace intervention focused on developing sustainable leadership and work-team practices to support the delivery of compassionate care. Control: No educational activity. Primary and secondary outcome measures Primary—Quality of Interaction Schedule (QuIS) for observed staff–patient interactions. Secondary—patient-reported evaluations of emotional care in hospital (PEECH); nurse-reported empathy (Jefferson Scale of Empathy). Results Trial proceeded as per protocol, randomisation was acceptable. Some but not all blinding strategies were successful. QuIS observations achieved 93% recruitment rate with 25% of patient sample cognitively impaired. At follow-up there were more total positive (78% vs 74%) and less total negative (8% vs 11%) QuIS ratings for intervention wards versus control wards. Sixty-three per cent of intervention ward patients scored lowest (ie, more negative) scores on PEECH connection subscale, versus 79% of control. This was not a statistically significant difference. No statistically significant differences in nursing empathy were observed. Conclusions Use of experimental methods is feasible. The use of structured observation of staff–patient interaction quality is a promising outcome measure inclusive of hard to reach groups. Trial registration number ISRCTN16789770.

Background Despite concerns about the degree of compassion in contemporary healthcare, there is a dearth of evidence for health service managers about how to promote compassionate healthcare. This paper reports on the implementation of the Creating Learning Environments for Compassionate Care (CLECC) intervention by four hospital ward nursing teams. CLECC is a workplace educational intervention focused on developing sustainable leadership and work-team practices designed to support team relational capacity and compassionate care delivery. Objectives To identify and explain the extent to which CLECC was implemented into existing work practices by nursing staff, and to inform conclusions about how such interventions can be optimised to support compassionate care in acute settings. Methods Process evaluation guided by normalisation process theory. Data gathered included staff interviews (n=47), observations (n=7 over 26 hours) and ward manager questionnaires on staffing (n=4). Results Frontline staff were keen to participate in CLECC, were able to implement many of the planned activities and valued the benefits to their well-being and to patient care. Nonetheless, factors outside of the direct influence of the ward teams mediated the impact and sustainability of the intervention. These factors included an organisational culture focused on tasks and targets that constrained opportunities for staff mutual support and learning. Conclusions Relational work in caregiving organisations depends on individual caregiver agency and on whether or not this work is adequately supported by resources, norms and relationships located in the wider system. High cognitive participation in compassionate nursing care interventions such as CLECC by senior nurse managers is likely to result in improved impact and sustainability.